Raechele Cochran Gathers, MD “I am trying to figure out if I have psoriasis or dermatitis. My scalp is covered in flakes that look like crust. My forehead area around my hairline has scales that are extremely dry and look like sunburn. When I scratch my scalp, it’s red and sometimes bleeds and burns. The lymph nodes at the back of my scalp are very swollen and painful. My hair is natural and it’s extremely embarrassing. Please help!”
A flaking and scaling scalp can be physically miserable and down right embarrassing. Who wants to have huge dandruff flakes on their shoulders? Besides the itch, burn and unsightly nature of severe dandruff, a flaking and burning scalp can sometimes indicate a problem much bigger and much more serious than just run-of-the-mill dandruff. Also, if you have a flaking and burning scalp, this inflammation can sometimes lead to a scalp infection that can cause hair loss and even scarring on your scalp.
Causes of Flaking and Burning Scalp
1. Seborrheic Dermatitis
You can think of seborrheic dermatitis as a form of ‘extreme dandruff,’ affecting not just the scalp, but sometimes the areas around the hairline, the eyebrows, and even in the creases between your nose and mouth. Seborrheic dermatitis looks like yellow-white, thick and greasy scaling in your scalp. The scaling may be all over, or in just a few areas. If you peel the scale back, you might notice that your scalp is red and inflamed looking underneath. Seborrheic dermatitis is caused by an abnormal response to yeast on the scalp, called Malassezia furfur. Besides causing a flaking and burning scalp, seborrheic dermatitis can also lead to discoloration and scaling around your hairline.
2. Psoriasis
Psoriasis is an autoimmune disease that can cause your scalp to be red and inflamed. You might also notice flaking and burning in your scalp and might develop thick brown or grayish colored scales on your scalp. Compared to seborrheic dermatitis, the scales of psoriasis are often more adherent (stick to your scalp more) and are more likely to lead to bleeding if you pull them away. Psoriasis is considered to be a chronic condition, which means that while there are effective treatments for it, there is no known cure. It’s more common in whites, but people of color get it too. Besides sometimes causing a flaking and burning scalp, psoriasis often causes thick scaling dark patches on your elbows, knees and back—in addition to other areas. It might also cause joint pains and cause you to have deformed and unsightly fingernails.
3. Contact Dermatitis
Contact dermatitis is a red, itchy, often scaling rash that happens when your skin or scalp comes into contact with something. Some people develop a contact dermatitis from a substance that irritates the skin or scalp, like a glue or sometimes hair from extensions or braids. Contact dermatitis can also be caused by contact with something that you’re allergic to. For instance, people who are allergic to certain hair dyes can develop itching, a flaking and burning scalp, and even enlarged lymph nodes after dyeing the hair.
4. Folliculitis
Folliculitis is inflammation of the hair follicles. It can be caused by bacteria, fungus, or chemicals that irritate the scalp, or even from trauma from a tight weave or braids. Folliculitis usually looks like flesh colored or pink bumps and small pus bumps on the scalp and around the hairs. It can sometimes cause a flaking and burning scalp and can also cause you to have tender and enlarged lymph nodes.
5. Ringworm
Ringworm of the scalp is a fungal infection of the scalp. The medical term for it is tinea capitis. Most people think of scalp ringworm as being a disease that kids get. But it can occur in adults and can cause hair loss, flaking, itching and scaling on your scalp. You can read more about scalp ringworm and how we treat it here.
6. Discoid Lupus Erythematosus (DLE)
DLE is a form of lupus, a serious autoimmune disease. In lupus, the immune system begins to attack and destroy your body’s own healthy tissues and organs. DLE can affect any area of the skin, but it often shows up on the scalp, ears and face. Many first notice DLE because they develop tender spots on their scalps. Sometimes these spots are scaly and they can burn and be uncomfortable. If you have DLE, it’s super important to be diagnosed and start a treatment plan, because it can lead to permanent scarring on your face and scalp and hair loss.
Treatments
For mild scaling, flaking and dandruff on your scalp, you can try the following shampoo treatments which can be quite helpful. All of these are commonly recommended by dermatologists:
Neutrogena T Gel 
Head and Shoulders
Nizoral 
But remember, if you’re suffering from dandruff, scalp irritation and burning of your scalp, it’s important to see a dermatologist. There are many causes of scalp flaking and burning. Some of them are more serious than others. It’s important that you find out what’s going on so that the problem can be quickly treated!
